Minnesota Health Care Administrative Simplification
|
|
|
- Iris Long
- 8 years ago
- Views:
Transcription
1 Minnesota Health Care Administrative Simplification Prepared for a meeting of the Oregon Health Policy and Research Administrative Simplification Work Group, March 30, 2010 David K. Haugen, Minnesota Department of Health 1
2 Overview Answer five questions (and provide context and background in the process) 1. State role: What is the state s role in admin simp in MN? Why did state leaders conclude that a state role was necessary? 2. Priorities: Why did MN choose the priorities you did? What do you see as the next priorities? 3. Savings: How did MN measure potential savings from simplification activities? [How detailed are the measures?] 4. Public benefit: Do you expect admin simp savings to flow through to taxpayers and the public? How? 5. Adoption in Oregon: One model -- set deadlines for private sector to develop a standard if not met will result in state imposition of an existing standard? Would it make sense to use MN standard as a fall-back? When will your 5010 uniform guides be ready? Specific lessons, challenges, practical considerations in implementing Minnesota s rules 2
![Savings: How did MN measure potential savings from simplification activities? [How detailed are the measures?] 4.](/docs-images/57/5614276/images/page_2.jpg "Public benefit: Do you expect admin simp savings to flow through to taxpayers and the public? How? 5.")
3 MN Administrative Simplification Act (ASA) 1. What is state s role? Why was state role necessary? Part of larger, ongoing health care reforms (ASA passed in 1994) Goals: Reduce health care administrative costs and burdens Improve accuracy and usefulness of administrative data Initial focus: Standard paper claims forms Minnesota Administrative Uniformity Committee (AUC) Voluntary; free to join; stakeholders -- providers, payers, associations, state agencies; open, public process 3
4 MN Administrative Simplification Act (ASA) 1. What is state s role? Why was state role necessary? Minnesota Department of Health (MDH) implements, administers ASA Government -- needs/opportunities for variety of roles Neutral convener, facilitator, catalyst Resources and resource coordinator Technical assistance, staffing, institutional memory Communication, coordination with other states, regional, national efforts Compliance and enforcement 4
5 Recent amendments to the ASA (MN Statutes 62J.536) 2007 Standard, electronic exchange of health care administrative transactions 2008 Compliance and enforcement added Other reinforcing laws: Additional reinforcing e-billing requirements for MN Workers Comp, property-casualty, and auto claims in
6 2007 Amendments to ASA (Minnesota Statues 62J.536) All health care providers and all group purchasers (payers) must exchange 3 administrative transactions electronically Rules for single, common data content and format Eligibility inquiries and responses (1/15/09) Claims (Institutional, Professional, Dental, Pharmacy) (7/15/09) Payment remittance advices (12/15/09) Affects: Nearly 60,000 providers payers Includes national payers licensed or doing business in MN 6
7 2007 law addressed 3 key problem areas 2. Why did MN choose the priorities it did? 1. Many administrative transactions are still paper-based Solution: Require 3 common transactions be exchanged electronically 2. Proliferation of companion guides creates non-standard transactions Solution: Require single, uniform companion guide (single standard data content and format) 3. Many payers are exempt from HIPAA requirements Solution: Requirements for claims, remits apply to non-hipaa covered payers Non-HIPAA covered payers exempted from eligibility requirement because transaction does not meet business needs 7
8 Started with 3 key transactions 2. Why did MN choose the priorities it did? Choices reflect stakeholder input regarding: Key transactions in business cycle Common, high volume, high value transactions (opportunities for impact, savings) Practical (HIPAA adopted standards; familiar transactions; many claims already sent electronically) Other additional transactions are possible in the future 8
9 Uniform companion guide rule making process Commissioner of Health rules for single, uniform companion guides Based on HIPAA, Medicare standards Developed in consultation with MN Administrative Uniformity Committee (AUC) Open, public process Modifications from Medicare by the Commissioner as deemed appropriate Opportunities for public comment Final rules must be adopted at least one year prior to having the force of law 9
10 10
11 Periodic updates of rules 1/16/09 -- CMS adopted Version 5010 for HIPAA transactions NCPDP D.0 for pharmacy claims 5010/D.0 in effect January 1, /D.0 may be used prior to 1/01/2012 by mutual agreement between trading partners Level 1 compliance by December 31, 2010 Create, receive 5010, complete internal readiness CMS also adopted ICD-10, effective 10/1/
12 v.5010 MN Companion Guides Rules Development Developed in consultation with AUC Proposed eligibility and claims Guides (rules) Feb. 8, day public comment period over, MDH reviewing comments in consultation with AUC Proposed remittance advice Guides Mar. 1; public comment period through Mar. 30 Final rules expected mid-2010 Provide lead time for CMS 12/31/10 Level I and 1/1/2012 Level 2 compliance 12
13 MN Uniform Companion Guides Implementation and Use Time period Now until adoption of MN v5010 guides (mid-2010) Companion Guides Only the MN v4010 After adoption of MN v5010 guides (mid-2010) to 1/1/2012 Either of the following: MN v41010 MN v5010 (By mutual agreement between trading partners) Starting Jan. 1, 2012 Only the MN v
14 2008: Implementation and Compliance MDH is to assure compliance Statute emphasizes: Voluntary compliance; may provide technical assistance Enforcement is complaint-driven MDH to seek informal resolution of complaints If informal resolution not possible penalties (fines) may be imposed Mitigating factors may be considered in determining any penalties Ability to contest and appeal 14
15 Estimated potential annual cost savings 3. Estimates of potential cost savings? MDH -- very preliminary, conservative, estimates of overall system-wide savings Total MN annual health care spending: More than $40 billion annually Share of total spending due to costs of 3 transactions: 2% ($800 million annually) Possible reduction in annual administrative costs when MN rules fully implemented ( ) At least 7% reduction in costs 7% reduction off $800 million current costs =.07 x $800 million = $56 million projected annual savings, system-wide 15
16 Public benefit 4. Benefits to taxpayers, public? How? Many potential benefits of standard EDI transactions Difficult to quantify amount, flows to taxpayers, public Greater efficiencies, lower back office costs may translate into: Lower insurance premium costs, lower Medicaid costs; Investments that improve patient care and outcomes; Fewer problems for consumers obtaining care, or for claims improperly denied or paid Standard, accurate, administrative EDI is foundational Quality improvement, health care planning Broad benefits for consumers and taxpayers 16
17 Adoption in Oregon 5. Adoption in Oregon? Use of MN? Important considerations: Oregon is committed to health care administrative simplification Will be working with stakeholders to reach goals by a date certain If the deadline is not met, state could specify in advance: a default, or a process by which the state will create single, uniform companion guides (and timeline for implementing). 17
18 Adoption in Oregon 5. Adoption in Oregon? Use of MN? Proposed MN 5010 Guides published, final versions ready by mid-2010 Minnesota Guides vetted through AUC and public comment Public domain and free National recognition MN guides apply to payers nationally, other national audiences aware Minnesota encourages other states to use/adopt Guides 18
19 Some Lessons, Challenges, and Practical Considerations Single, uniform companion guides can be developed through a multi-stakeholder process and implemented in the timeframes given Too early for evaluation of impact, but preliminary indications are positive Enforcement seems appropriately balanced Connectivity and connecting were initially bigger challenges than anticipated 19
20 Some Lessons, Challenges, and Practical Considerations Communication and outreach are important, especially for smaller providers and non-hipaa covered payers Need development lab/parking lot (e.g., SBARs, FAQs, best practices ) Claims attachments, COB, common coding are challenging Need to coordinate with other federal reforms and regulations (federal health reform, 5010, EHR standards for meaningful use) 20
21 Connectivity and connecting Clearinghouses Information needed to make connections sometimes difficult to obtain Sometimes not connecting with other clearinghouses Some charging fees inappropriately Difficulty obtaining information needed to make connections EDI yellow pages needed Minnesota list of payers, survey 21
22 22
23 Outreach, education, technical assistance Variety of experience, familiarity with concepts and requirements, access to resources and assistance MDH providing information, assistance within limited scope, resources Particular needs: Smaller providers Non-HIPAA covered payers (workers compensation, property casualty, and auto) Other industry responses and developments Trade associations and professional organizations Educational forums, vendor displays MN Council of Health Plans arranged for free, web-based tool for submitting claims to Minnesota health plans 23
24 Outreach, education, technical assistance Significant efforts AUC process (over 160 public meetings and teleconferences in 2009) MDH provides AUC with meeting facilities, conference lines, webinar capabilities, staffing, consulting resources Other ongoing MDH communication/tech assistance: two websites, list serve, press releases, industry press, targeted mailings, presentations and meetings, coordination with provider/payer/association organizations MDH responded to over 1500 individual and voice inquiries in
25 Development lab/parking lot Need place, process for non-rule clarifications, elaborations Consensus recommendations, information without the force of law Can be a way to arrive at consensus, test in practice before subsequently adopting as a rule Examples: Best practices, FAQs, coding clarification grid 25
26 26
27 Claims Attachments Minnesota law does not require electronic claims attachments (claims must be electronic) No national HIPAA standard Especially an issue with workers compensation claims Instructions in Guide (rule) for submitting attachments Populate PWK segment, provide unique control no. Best practice (elaboration) and standard cover sheet for faxed attachments 27
28 Coordination of benefits (COB) Submit CAS segment information from previous payer s remittance advice If no previous compliant electronic remittance, submit using PWK segment and forward the paper remittance advice Per attachment instructions (previous slide) MN Guides do not apply to payer to payer transactions However, best practice outlines payer to payer recommendation 28
29 Common coding Determining what Medicare requirements are Requirements, recommendations when Medicare does not apply E.g. pediatrics, services not covered by Medicare Service delivery innovations Baskets of care, new types of services (comprehensive treatments for substance abuse, eating disorders, others) 29
30 MN near-term work plan Complete v5010/d.0 implementation Plan for federal legislation Patient Protection and Affordable Care Act Meaningful use incentives and Electronic Health Record (EHR) standards Possible development of Minnesota Uniform Companion Guides for Acknowledgments Studies, development projects mandated by law 30
31 Thank you Contact information: David K. Haugen -- Director, Center for Health Care Purchasing Improvement Helpful websites: MDH Administrative Simplification Act (ASA): Minnesota Administrative Uniformity Committee (AUC) Minnesota Health Reform 31
Understanding the HIPAA standard transactions: The HIPAA Transactions and Code Set rule
Understanding the HIPAA standard transactions: The HIPAA Transactions and Code Set rule Many physician practices recognize the Health Information Portability and Accountability Act (HIPAA) as both a patient
HIPAA: AN OVERVIEW September 2013
HIPAA: AN OVERVIEW September 2013 Introduction The Health Insurance Portability and Accountability Act of 1996, known as HIPAA, was enacted on August 21, 1996. The overall goal was to simplify and streamline
Meaningful Use, ICD-10 and HIPAA 5010 Overview, talking points and FAQs
Meaningful Use, ICD-10 and HIPAA 5010 Overview, talking points and FAQs Providence Health & Services is committed to using technology and evidence-based practices to deliver the highest quality care in
Subchapter G. Electronic Medical Billing, Reimbursement, and Documentation 133.500 & 133.501
Page 1 of 22 pages Subchapter G. Electronic Medical Billing, Reimbursement, and Documentation 133.500 & 133.501 1. INTRODUCTION. The Commissioner of the Division of Workers' Compensation, Texas Department
HIPAA Administrative Simplification and Privacy (AS&P) Frequently Asked Questions
HIPAA Administrative Simplification and Privacy (AS&P) Frequently Asked Questions ELECTRONIC TRANSACTIONS AND CODE SETS The following frequently asked questions and answers were developed to communicate
Transitioning to EDI HIPAA 5010 and ICD-10
Transitioning to EDI HIPAA 5010 and ICD-10 Challenges & Opportunities October 17, 2010 Outline I. HIPAA 5010 EDI Changes HIPAA 5010 Overview Transactions Affected CORE Certification II. III. IV. ICD-10
Committee on Operating Rules For Information Exchange (CORE )
Committee on Operating Rules For Information Exchange (CORE ) Public Town Hall Call March 13, 2012 Additional information/resources available at www.caqh.org Agenda Brief Overview of CAQH CORE For more
All Providers, Clearinghouses, Billing Services, and Value Added Networks HIPAA Readiness Checklist and Timeline
P R O V I D E R B U L L E T I N B T 2 0 0 3 6 3 S E P T E M B E R 3 0, 2 0 0 3 To: Subject: All Providers, Clearinghouses, Billing Services, and Value Added Networks Overview The Indiana Office of Medicaid
Submitted via Federal erulemaking Portal
Response to Administrative Simplification: Adoption of a Standard for a Unique Health Plan Identifier; Addition to the National Provider Identifier Requirements; and a Change to the Compliance Date for
HIPAA 5010 It is important to prepare now Deanna Stohl ETP Contracting and Relations e-business Interchange Group Blue Cross Blue Shield Michigan
HIPAA 5010 It is important to prepare now Deanna Stohl ETP Contracting and Relations e-business Interchange Group Blue Cross Blue Shield Michigan August 31, 2011 1 Housekeeping Please place your phones
Federal Operating Rules for Healthcare Administrative Simplification
Federal Operating Rules for Healthcare Administrative Simplification Gwendolyn Lohse, Deputy Director CAQH Ann Brisk, VP Health Care Transaction Services, OptumHealth Financial Priscilla Holland, Senior
Electronic Billing, EFT and other EDI Initiatives for Workers Compensation
Electronic Billing, EFT and other EDI Initiatives for Workers Compensation Presentation to North Carolina MGMA Workers Compensation Committee September 10, 2014 Don St. Jacques, SVP Business Development
GEORGIA MEDICAL BILLING AND REIMBURSEMENT FOR WORKERS COMPENSATION
Approved GEORGIA MEDICAL BILLING AND REIMBURSEMENT FOR WORKERS COMPENSATION Table of Contents Section 1: Section 2: Section 3: Section 4: Section 5: Section 6: Section 7: Section 8: Section 9: Section
NCPDP Electronic Prescribing Standards
NCPDP Electronic Prescribing Standards September 2014 1 What is NCPDP? An ANSI-accredited standards development organization. Provides a forum and marketplace for a diverse membership focused on health
CMS Proposed Electronic Health Record Incentive Program For Physicians
May 7, 2012 Ms. Marilyn Tavenner Acting Administrator Centers for Medicare and Medicaid Services Department of Health and Human Services Attention: CMS-0044-P Mail Stop C4-26-05 7500 Security Boulevard
Ross D. Seymour, MTPM
Health Care Reform and Funding Incentives Ross D. Seymour, MTPM HIPAA Certified Project Manager Orange, California Disclosure This presentation was current at the time it was published. Medicare policy
Oregon Workers Compensation Division Electronic Billing and Payment Companion Guide. Release 1.0 January 1, 2015
Oregon Workers Compensation Division Electronic Billing and Payment Companion Guide Release 1.0 January 1, 2015 i Purpose of the Electronic Billing and Remittance Advice Guide This guide has been created
States and HIPAA information
States and HIPAA information Prepared by: Jennifer Bible, MSW Alabama: Alabama s Medicaid website contains HIPAA information at http://www.medicaid.alabama.gov/resources/hipaa.aspx?tab=5. Extensive FAQ
How To Write A Core Rule
Committee on Operating Rules for Information Exchange (CORE ) Phase III CORE 360 Uniform Use of Claim Adjustment Reason Codes and Remittance Advice Remark Codes (835) Rule Table of Contents 1 Background
ICD-10. New Mexico Medicaid. Presenter: Xerox State Healthcare LLC Provider Field Representative
ICD-10 New Mexico Medicaid Presenter: Xerox State Healthcare LLC Provider Field Representative Purpose This training will provide an overview ICD-10 and what providers should do to prepare for the transition
Administrative Simplification Operating Rules
Administrative Simplification Operating Rules April 8, 2014 Geanelle Herring Policy Analyst, Administrative Simplification Group Centers for Medicare & Medicaid Services Priscilla Holland, AAP, CCM Senior
CLAIMS Section 5. Overview. Clean Claim. Prompt Payment. Timely Claims Submission. Claim Submission Format
Overview The Claims department partners with the Provider Relations, Health Services and Customer Service departments to assist providers with any claims-related questions. The focus of the Claims department
Executive Memorandum No. 27
OFFICE OF THE PRESIDENT HIPAA Compliance Policy (effective April 14, 2003) Purpose It is the purpose of this Executive Memorandum to set forth the Board of Regents and the University Administration s Policy
HIPAA Transactions and Code Set Standards As of January 2012. Frequently Asked Questions
HIPAA Transactions and Code Set Standards As of January 2012 Frequently Asked Questions Version 20 Rev 11222011 Frequently Asked Questions: HIPAA Transactions and Code Set Standards One of the most prominent
INTERMEDIATE ADMINISTRATIVE SIMPLIFICATION CENTERS FOR MEDICARE & MEDICAID SERVICES. Online Guide to: ADMINISTRATIVE SIMPLIFICATION
02 INTERMEDIATE» Online Guide to: CENTERS FOR MEDICARE & MEDICAID SERVICES Last Updated: February 2014 TABLE OF CONTENTS INTRODUCTION: ABOUT THIS GUIDE... i About Administrative Simplification... 2 Why
DY574_261023_br. OMPP MMIS HIPAA 5010 /Edifecs Project. Overview
OMPP MMIS HIPAA 5010 /Edifecs Project HIPAA 5010/Edifecs Project Implementation HIPAA 5010/Edifecs Project Implementation Overview Project purpose Comply with CMS HIPAA 5010/D.0 EDI standard The Centers
Blue Cross and Blue Shield of Texas (BCBSTX)
Blue Cross and Blue Shield of Texas (BCBSTX) 835 Electronic Remittance Advice (ERA) Companion Guide Refers to the Implementation Guides Based on ASC X12 version 005010 Version 1.0 BCBSTX January 2014 A
WEDI ICD-10 Emergency Summit Summary
WEDI ICD-10 Emergency Summit Summary This document summarizes key discussion areas from the WEDI Emergency ICD-10 Summit held April 30, 2014 in response to the ICD-10 compliance date change necessitated
Health Insurance Portability and Accountability Act HIPAA. Glossary of Common Terms
Health Insurance Portability and Accountability Act HIPAA Glossary of Common Terms Terms: HIPAA Definition*: PHCS Definition/Interpretation: Administrative Simplification HIPAA Subtitle F It is the purpose
ICD-10 Compliance Date. Frequently Asked Questions. ICD-10 Implementation Frequently Asked Questions Updated September 2014
ICD-10 Implementation Frequently Asked Questions Updated September 2014 ICD-10 Compliance Date The U.S. Department of Health and Human Services (HHS) issued a rule on July 31, 2014 finalizing October 1,
ICD-10 Preparation for Dental Providers. July 2014
ICD-10 Preparation for Dental Providers July 2014 What is ICD-10? The International Classification of Diseases (ICD) is a set of codes used worldwide to classify medical diagnoses and inpatient procedures.
MEDICAID MISSISSIPPI PRE ENROLLMENT INSTRUCTIONS 77032
MEDICAID MISSISSIPPI PRE ENROLLMENT INSTRUCTIONS 77032 HOW LONG DOES PRE ENROLLMENT TAKE? Standard processing time is 1 2 weeks. WHAT FORM(S) SHOULD I COMPLETE? EDI Provider Agreement and Enrollment Form
SERIES 1 ALL-PAYER CLAIMS DATABASE --DATA SUBMISSION REQUIREMENTS
TITLE 114A JOINT LEGISLATIVE RULE SECRETARY OF THE DEPARTMENT OF HEALTH AND HUMAN RESOURCES, INSURANCE COMMISSIONER, AND THE CHAIR OF THE HEALTH CARE AUTHORITY SERIES 1 ALL-PAYER CLAIMS DATABASE --DATA
Health Plan Certification of Compliance with HIPAA Electronic Transaction Standards
Issue 1 2014 Health Plan Certification of Compliance with HIPAA Electronic Transaction Standards The Department of Health and Human Services ( HHS ) issued proposed regulations that will require a controlling
Welcome to AlohaCare s ICD-10 Information Session
Welcome to AlohaCare s ICD-10 Information Session 1 Overview AlohaCare Introduction ICD-10 Primer AlohaCare & ICD-10 ICD-10 Coding Workflow Considerations for Outpatient Orders Questions/Comments This
Health Insurance Exchange Study
Health Insurance Exchange Study Minnesota Department of Health February, 2008 Division of Health Policy Health Economics Program PO Box 64882 St. Paul, MN 55164-0882 (651) 201-3550 www.health.state.mn.us
Health Reform and the AAP: What the New Law Means for Children and Pediatricians
Health Reform and the AAP: What the New Law Means for Children and Pediatricians Throughout the health reform process, the American Academy of Pediatrics has focused on three fundamental priorities for
Patient Protection and Affordable Care Act of 2009: Health Insurance Exchanges
Patient Protection and Affordable Care Act of 2009: Health Insurance Exchanges Provision Notes Standards SUBTITLE D AVAILABLE COVERAGE CHOICES FOR ALL AMERICANS PART I Establishment of Qualified Health
Department of Health and Human Services. No. 172 September 5, 2012. Part II
Vol. 77 Wednesday, No. 172 September 5, 2012 Part II Department of Health and Human Services Centers for Medicare & Medicaid Services 45 CFR Part 162 Administrative Simplification: Adoption of a Standard
PART 2. TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION SERVICE TITLE 4. AGRICULTURE TITLE 28. INSURANCE
TITLE 4. AGRICULTURE PART 12. SERVICE TEXAS A&M FOREST CHAPTER 215. FOREST ZONE DETERMINATION PROCEDURE 4 TAC 215.1, 215.5, 215.9, 215.13, 215.17, 215.21, 215.35 Texas A&M Forest Service (Agency) adopts
North Carolina Workers Compensation Electronic Billing and Payment Companion Guide
North Carolina Workers Compensation Electronic Billing and Payment Companion Guide Based on ASC X12 005010 and NCPDP D.0 Release 2.0 February 21, 2014 Important Note The International Association of Industrial
ICD-10 Overview. The U.S. Department of Health and Human Services implementation deadline for compliance with ICD-10, Mandate is October 1, 2014.
ICD-10 Overview ICD-10 is the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD), a medical classification list by the World Health Organization
CMS AND ONC FINAL REGULATIONS DEFINE MEANINGFUL USE AND SET STANDARDS FOR ELECTRONIC HEALTH RECORD INCENTIVE PROGRAM
CMS AND ONC FINAL REGULATIONS DEFINE MEANINGFUL USE AND SET STANDARDS FOR ELECTRONIC HEALTH RECORD INCENTIVE PROGRAM The Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator
Thursday, March 28, 2013 2:00-3:00 PM ET
Property and Casualty Electronic Medical Bill (ebill) Subworkgroup- Bringing Automation into the Property & Casualty Industry: Overview of ebilling and How it Works Thursday, March 28, 2013 2:00-3:00 PM
Single Formulary Electronic Prior Authorization Reporting Requirements. Department of Vermont Health Access December 14 th, 2011
Single Formulary Electronic Prior Authorization Reporting Requirements Department of Vermont Health Access December 14 th, 2011 1 Today s Agenda Legislation Formulary Development Single Formulary Rationale
Introduction. By Santhosh Patil, Infogix Inc.
Enterprise Health Information Management Framework: Charting the path to bring efficiency in business operations and reduce administrative costs for healthcare payer organizations. By Santhosh Patil, Infogix
Title 40. Labor and Employment. Part 1. Workers' Compensation Administration
Title 40 Labor and Employment Part 1. Workers' Compensation Administration Chapter 3. Electronic Billing 301. Purpose The purpose of this Rule is to provide a legal framework for electronic billing, processing,
Center for Healthcare Transparency
RFP Contents I. Project Description and Background II. Funding Available III. Proposal Requirements IV. Proposal Scoring V. Proposal Submission Process VI. Proposal Documents I. Project Description and
MEDICAID BASICS BOOK Third Party Liability
Healthy Connections Visual MEDICAID BASICS BOOK Third Party Liability An illustrated companion to the interactive courses at: MedicaideLearning.com. This topic includes content from the exclusive Third
The Transition to Version 5010 and ICD-10
The Transition to Version 5010 and ICD-10 An Overview Denise M. Buenning, MsM Director, Administrative Simplification Group Office of E-Health Standards and Services Centers for Medicare & Medicaid Services
Molina Healthcare Post ICD 10 FAQ
Molina Healthcare Post ICD 10 FAQ On March 31, 2014, the Senate voted to approve a bill to delay the implementation of ICD-10-CM/ PCS by at least one year. President Obama signed the bill into law on April
Chapter 4: Electronic Data Interchange
Electronic Billing NOTE: ELECTRONIC CLAIM SUBMISSION IS REQUIRED UNDER SECTION 3 OF THE ADMINISTATIVE SIMPLIFICATION COMPLIANCE ACT (ASCA), PUB.L. 107-105, AND THE IMPLEMENTING REGULATION AT 42 CFR 424.32.
Georgia State Board of Workers Compensation Electronic Billing and Payment National Companion Guide (Based on ASC X12 005010 and NCPDP D.
Georgia State Board of Workers Compensation Electronic Billing and Payment National Companion Guide (Based on ASC X12 005010 and NCPDP D.0) Release 2.0 September 10, 2012 Purpose of the Electronic Billing
Request for Proposals. Privacy, Security and Consent Management for. Electronic Health Information Exchange
Request for Proposals Privacy, Security and Consent Management for Electronic Health Information Exchange Part A and Part B Part A: Review of e-health Legal Issues, Analysis and Identification of Leading
The benefits of electronic claims submission improve practice efficiencies
The benefits of electronic claims submission improve practice efficiencies Electronic claims submission vs. manual claims submission An electronic claim is a paperless patient claim form generated by computer
California Division of Workers Compensation Electronic Medical Billing and Payment Companion Guide
California Division of Workers Compensation Electronic Medical Billing and Payment Companion Guide Version 1.0 2012 Preface California Electronic Medical Billing and Payment Companion Guide Purpose of
The HIPAA Privacy Rule: Overview and Impact
The HIPAA Privacy Rule: Overview and Impact DISCLAIMER: This information is provided as is without any express or implied warranty. It is provided for educational purposes only and does not constitute
Financial Disclosure. Teri Thurston does not have any relevant financial relationships with any commercial interests
Financial Disclosure Teri Thurston does not have any relevant financial relationships with any commercial interests Transitioning to ICD-10 Planning the Journey for Implementation 2 Brief History of ICD-10
IAIABC Workers Compensation Electronic Billing and Payment National Companion Guide
IAIABC Workers Compensation Electronic Billing and Payment National Companion Guide Based on ASC X12 005010 and NCPDP D.0 Release 2.0 July 2012 IAIABC Workers' Compensation Electronic Billing and Payment
Introduction. Table of Contents
Table of Contents Introduction... 2 Billing Project Background... 2 Immunization Billing Manual Developed... 3 Topics in the Manual... 4 Section 1 - Participating Provider Application Process... 4 Section
ELECTRONIC DATA INTERCHANGE (EDI) TRADING PARTNER INSTRUCTIONS
ELECTRONIC DATA INTERCHANGE (EDI) TRADING PARTNER INSTRUCTIONS State Form 51400 (R/8-07) The (ISDH) is committed to conducting its business transactions with the health care provider community as efficiently
Version 5010 and ICD-10: Closer Than You Think
www.raconline.org Version 5010 and ICD-10: Kristine Sande, Moderator www.raconline.org Version 5010 New standard for HIPAA electronic transactions Takes effect January 1, 2012 ICD-10 Codes Transition happens
Alert. Client PROSKAUER ROSE LLP. HIPAA Compliance Update: Employers, As Group Health Plan Sponsors, Will Be Affected By HIPAA Privacy Requirements
PROSKAUER ROSE LLP Client Alert HIPAA Compliance Update: Employers, As Group Health Plan Sponsors, Will Be Affected By HIPAA Privacy Requirements The U.S. Department of Health and Human Services published
AMENDMENT. 1. Replace in Amendment # 13, Item #1, page 1 of 12, with the following:
HP ENTERPRISE SERVICES, LLC PAGE 1 OF 10 AMENDMENT It is hereby agreed by and between the State of Vermont, Agency of Human Services, Department of Vermont Health Access (hereafter referred to as the State
ICD-10: Business Continuity Contingency Plans. Presenter: D. Keith Hatch, Florida Blue, Consultant, EDI Operational Assessment
ICD-10: Business Continuity Contingency Plans Presenter: D. Keith Hatch, Florida Blue, Consultant, EDI Operational Assessment Presentation Content Purpose Provide an overview of activities to ensure operational
Emdeon Claims Provider Information Form *This form is to ensure accuracy in updating the appropriate account
PAYER ID: SUBMITTER ID: Emdeon Claims Provider Information Form *This form is to ensure accuracy in updating the appropriate account 1 Provider Organization Practice/ Facility Name Provider Name Tax ID
Title 40 LABOR AND EMPLOYMENT Part I. Workers' Compensation Administration Subpart 1. General Administration Chapter 3. Electronic Billing
NOTICE OF INTENT Louisiana Workforce Commission Office of Workers' Compensation Electronic Medical Billing and Payment Companion Guide (LAC 40:I:305,306) Notice is hereby given, in accordance with R.S.
FAQ ICD 10. Categories: Compliance Billing General Claims Testing COMPLIANCE: Q. When is the ICD 10 compliance deadline? A.
FAQ ICD 10 Categories: Compliance Billing General Claims Testing COMPLIANCE: Q. When is the ICD 10 compliance deadline? A. October 1, 2015 Q. What does ICD 10 compliance mean? A. IDC 10 compliance means
Complaint Investigations of Minnesota Health Care Facilities
Complaint Investigations of Minnesota Health Care Facilities Report to the Minnesota Legislature explaining the investigative process and summarizing investigations from State Fiscal Year 2009 through
Health Information Technology
Background Brief on September 2014 Inside this Brief Terminology Relevant Federal Policies State HIT Environment, Policy, and HIT Efforts Staff and Agency Contacts Legislative Committee Services State
HIPAA Frequently Asked Questions Free & Charitable Clinic HIPAA Toolbox May 2014
HIPAA Frequently Asked Questions Free & Charitable Clinic HIPAA Toolbox May 2014 Following is a list of FAQs answered by Ropes & Gray, a law firm focusing on health care practices, on behalf of AmeriCares
Details for: CMS PROPOSES DEFINITION OF MEANINGFUL USE OF CERTIFIED ELECTRONIC HEALTH RECORDS (EHR) TECHNOLOGY. Wednesday, December 30, 2009
Details for: CMS PROPOSES DEFINITION OF MEANINGFUL USE OF CERTIFIED ELECTRONIC HEALTH RECORDS (EHR) TECHNOLOGY Return to List For Immediate Release: Contact: Wednesday, December 30, 2009 CMS Office of
HEALTH CARE REFORM TIME TO PREPARE FOR 2014 OCTOBER 2012
HEALTH CARE REFORM TIME TO PREPARE FOR 2014 OCTOBER 2012 Key elements of health reform for employers Change in tax treatment for overage dependent coverage Accounting impact of change in Medicare retiree
ICD-10: Industry Perceptions and Readiness
ICD-10: Industry Perceptions and Readiness John Kasey Andrew Naugle, MBA Patricia Zenner, RN Introduction to ICD-10 The U.S. healthcare industry is poised to undergo many radical changes in the coming
Reporting Requirements for Employers and Health Plans
Brought to you by Cross Employee Benefits Reporting Requirements for Employers and Health Plans The Affordable Care Act (ACA) created a number of federal reporting requirements for employers and health
Minnesota Department of Health (MDH) Rule
Minnesota Department of Health (MDH) Rule Title: Pursuant to Statute: Applies to/interested parties: Description of this document: Status of this document: Minnesota Uniform Companion Guide (MUCG) Version
Transitioning Low-Income Children from a Separate Children s Health Insurance Program (CHIP) to Medicaid October 18, 2013
DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services 7500 Security Boulevard, Mail Stop S2-26-12 Baltimore, MD 21244-1850 Center for Medicaid and CHIP Services Transitioning
Administrative Inefficiency in Coordination of Benefits
Administrative Inefficiency in Coordination of Benefits Prepared with assistance from Manatt Health Solutions February 2014 EXECUTIVE SUMMARY Ineffective coordination of benefits (COB) the process to determine
Health Insurance Exchange Overview
Health Insurance Exchange Overview Minnesota Health Insurance Exchange Advisory Task Force November 8, 2011 Overview Existing Market Challenges What is an Exchange? Exchange Opportunities Exchange Components
Health Insurance Portability and Accountability Act December 2002 No. 7 PHC 1920
HIPAA insight Health Insurance Portability and Accountability Act December 2002 No. 7 PHC 1920 The information in HIPAA insight applies to billing vendors, Medicaid HMOs and other managed care programs,
SECURE EDI ENROLLMENT AGREEMENT INSTRUCTIONS. Select if this is a new application, change of submitter, update.
Notification Secure EDI provides this agreement as a courtesy for our customers. We make every effort to keep these forms updated however; the payer may not always notify us when changes have been made
Molina Healthcare of Ohio, Inc. PO Box 22712 Long Beach, CA 90801
Section 9. Claims As a contracted provider, it is important to understand how the claims process works to avoid delays in processing your claims. The following items are covered in this section for your
Section 9. Claims Claim Submission Molina Healthcare PO Box 22815 Long Beach, CA 90801
Section 9. Claims As a contracted provider, it is important to understand how the claims process works to avoid delays in processing your claims. The following items are covered in this section for your
MINNESOTA STATEWIDE QUALITY REPORTING AND MEASUREMENT SYSTEM:
MINNESOTA STATEWIDE QUALITY REPORTING AND MEASUREMENT SYSTEM: RISK ADJUSTMENT OF PHYSICIAN CLINIC QUALITY MEASURES * FOR PUBLIC REVIEW AND COMMENT The Minnesota Department of Health (MDH) invites interested
Proposed Adoption of Workers Compensation Rules
May 19, 2014 Proposed Adoption of Workers Compensation Rules The Workers Compensation Division proposes to adopt new rules to establish standards for electronic medical billing, OAR 436-008. Please review
RONALD V. MCGUCKIN AND ASSOCIATES Post Office Box 2126 Bristol, Pennsylvania 19007 (215) 785-3400 (215) 785-3401 (Fax) childproviderlaw.
RONALD V. MCGUCKIN AND ASSOCIATES Post Office Box 2126 Bristol, Pennsylvania 19007 (215) 785-3400 (215) 785-3401 (Fax) childproviderlaw.com HIPAA The Health Insurance Portability and Accountability Act
Health care reform for large businesses
FOR PRODUCERS AND EMPLOYERS Health care reform for large businesses A guide to what you need to know now DECEMBER 2013 CONTENTS 2 Introduction Since 2010 when the Affordable Care Act (ACA) was signed into
FMH Benefit Services, Inc.
FMH Benefit Services, Inc. HIPAA Transaction Electronic Data Interchange (EDI) Implementation Guide For Health Care Providers Version Number: 2.0 Issued: October 28, 2003 FMH Benefit Services, Inc. a division
REVISION, PROCEDURE CODING SYSTEM (ICD-10-PCS) VERSION 2.Ø
NCPDP IMPLEMENTATION TIMELINES AND RECOMMENDATIONS FOR INTERNATIONAL CLASSIFICATION OF DISEASES, 10TH REVISION, CLINICAL MODIFICATION (ICD-10- CM) AND THE INTERNATIONAL CLASSIFICATION OF DISEASES, 10TH
Call Center Assessment for the Vermont Health Exchange
Wakely Consulting Group Call Center Assessment for the Vermont Health Exchange August 24, 2012 1 0 0 C o n s t i t u t i o n C e n t e r * S u i t e 1 0 0 * B o s t o n, M A * 0 2 1 2 9 Table of Contents
ADDENDUM to. State of Washington Washington State Department of Social & Health Services Washington State Health Care Authority
ADDENDUM to State of Washington Washington State Department of Social & Health Services Washington State Health Care Authority Proposal to the Centers for Medicare and Medicaid Services State Demonstration
Legislative & Regulatory Information
Americas - U.S. Legislative, Privacy & Projects Jurisdiction Effective Date Author Release Date File No. UFS Topic Citation: Reference: Federal Various Louis Enahoro 2/20/14 LI-485 HIPAA, Electronic Commerce
American Health Benefit Exchanges Fact Sheet A Provision of the Patient Protection and Affordable Care Act (PPACA)
American Health Benefit Exchanges Fact Sheet A Provision of the Patient Protection and Affordable Care Act (PPACA) This Fact Sheet reflects the Final Ruling published by the Department of Health and Human
Medical Billing Standards and E-Billing
Medical Billing Standards and E-Billing 60 Attorneys in 14 Locations in California and Nevada Suzanne Honor-Vangerov, Esq. FS&K Sherry Wilson, V.P., Jopari Solutions www.fsklaw.com shonor@fsklaw.com 1
Medical Billing Requirements and ICD 10 Implementation Requirements
Are you ready for ICD 10? Denesecia Green, Senior Health Insurance Specialist Centers for Medicare & Medicaid Services Office of E Health Standards and Services ICD 10 Implementation The compliance deadline
HIPAA Version 5010: Thirteenth National Provider Call Provider Outreach and Education Transition Year Activities
HIPAA Version 5010: Thirteenth National Provider Call Provider Outreach and Education Transition Year Activities Amisha Pandya Division of Transaction Applications and Standards, Business Applications
2015-340B & Prime Vendor Program Update
2015-340B & Prime Vendor Program Update Christopher A. Hatwig, R.Ph., MS, FASHP President, Apexus 340B Sales by Entity Types Percentage of Total Apexus Participant Sales 90.00% 80.00% 70.00% 60.00% 50.00%
ICD-10 PREPARATION GUIDE PART II
ICD-10 PREPARATION GUIDE PART II More resources to prepare your physicians and staff, and to help work with your vendors to successfully implement the new code set. TABLE OF CONTENTS 3 Working with your
Maintaining the Privacy of Health Information in Michigan s Electronic Health Information Exchange Network. Draft Privacy Whitepaper
CHARTERED BY THE MICHIGAN HEALTH INFORMATION NETWORK SHARED SERVICES MIHIN OPERATIONS ADVISORY COMMITTEE (MOAC) PRIVACY WORKING GROUP (PWG) Maintaining the Privacy of Health Information in Michigan s Electronic
Qtr 2. 2011 Provider Update Bulletin
West Virginia Medicaid WEST VIRGINIA Department of Health & Human Resources Qtr 2. 2011 Provider Update Bulletin West Virginia Medicaid Provider Update Bulletin Qtr. 2, 2011 Volume 1 Inside This Issue: